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--- acupuncture:evaluation:rhumatologie - orthopedie:12. cervicalgies [25 Jul 2019 19:22]
Nguyen Johan [3. Recommandation de bonne pratique]
+++ acupuncture:evaluation:rhumatologie - orthopedie:12. cervicalgies [23 Oct 2025 07:59] (Version actuelle)
Nguyen Johan [3. Clinical Practice Guidelines]
@@ Ligne 1: / Ligne 1: @@
+/*English:Chronic Neck Pain*/
+=======  Chronic Neck Pain  =======
 ====== Cervicalgies : évaluation de l'acupuncture ======
-===== Revues systématiques et méta-analyses =====
+===== Systematic Reviews and Meta-Analysis=====
+==== Generic Acupuncture ====
+=== Fang 2024 ===
+Fang J, Shi H, Wang W, Chen H, Yang M, Gao S, Yao H, Zhu L, Yan Y, Liu Z. Durable Effect of Acupuncture for Chronic Neck Pain: A Systematic Review and Meta-Analysis. Curr Pain Headache Rep. 2024 Sep;28(9):957-969.  https://doi.org/10.1007/s11916-024-01267-x
+^Objective| Chronic neck pain, a prevalent health concern characterized by frequent recurrence, requires exploration of treatment modalities that provide sustained relief. This systematic review and meta-analysis aimed to evaluate the durable effects of acupuncture on chronic neck pain.|
+^Methods| We conducted a literature search up to March 2024 in six databases, including PubMed, Embase, and the Cochrane Library, encompassing both English and Chinese language publications. The main focus of evaluation included pain severity, functional disability, and quality of life, assessed at least 3 months post-acupuncture treatment. The risk of bias assessment was conducted using the Cochrane Risk of Bias 2.0 tool, and meta-analyses were performed where applicable.|
+^Results| **Eighteen randomized controlled trials** were included in the analysis. Acupuncture as an adjunct therapy could provide sustained pain relief at three (SMD: - 0.79; 95% CI - 1.13 to - 0.46; p < 0.01) and six (MD: - 18.13; 95% CI - 30.18 to - 6.07; p < 0.01) months post-treatment. Compared to sham acupuncture, acupuncture did not show a statistically significant difference in pain alleviation (MD: - 0.12; 95% CI - 0.06 to 0.36; p = 0.63). However, it significantly improved functional outcomes as evidenced by Northwick Park Neck Pain Questionnaire scores 3 months post-treatment (MD: - 6.06; 95% CI - 8.20 to - 3.92; p < 0.01). Although nine studies reported an 8.5%-13.8% probability of adverse events, these were mild and transitory adverse events.|
+^Conclusion| Acupuncture as an adjunct therapy may provide post-treatment pain relief lasting at least 3 months for patients with chronic neck pain, although it is not superior to sham acupuncture, shows sustained efficacy in improving functional impairment for over 3 months, with a good safety profile.|
+=== Yu 2024 ===
+Yu B, Yang Y, Fang J, Guo Y, Qiu Y, Yang S, Ran S, Zheng K, Wang T, Huang Y. Efficacy and safety of acupuncture treatment for stiff neck: A systematic review and meta-analysis. Medicine (Baltimore). 2024 Nov 8;103(45):e40415.  https://doi.org/10.1097/MD.0000000000040415
+^Backgound| Stiff neck is a common acute musculoskeletal condition that significantly affects the quality of life of patients. Acupuncture is recommended as an effective method for alleviating pain and restoring neck mobility in patients with stiff neck, but there is currently a lack of scientific evidence supporting its efficacy and safety. The purpose of this study was to investigate the efficacy and safety of acupuncture in the treatment of stiff neck.|
+^Method| This study searched 8 Chinese and English electronic medical databases, including China Biology Medicine disc, VIP database, Wanfang Data, China National Knowledge Infrastructure, Web of Science, PubMed, Embase, and the Cochrane Library, with a search period up to May 13, 2024. The focus was on clinical randomized controlled trials evaluating acupuncture treatment for stiff neck. The primary outcome measures were the total effective rate and visual analog scale scores. The quality of evidence and methodology of the included studies were assessed according to the GRADEpro guidelines. Meta-analysis was conducted to assess the results, with heterogeneity analysis, sensitivity analysis, subgroup analysis, trial sequential analysis, and publication bias analysis performed to verify the robustness of the combined results and explore potential sources of heterogeneity.|
+^Result| This study evaluated **10 clinical randomized controlled trials** comparing acupuncture therapy with conventional treatment, involving **754 patients**. The treatment group received acupuncture alone or in combination with conventional treatment, whereas the control group received only conventional treatment. The analysis results showed that the treatment group was significantly superior to the control group in improving the total effective rate (risk ratio = 1.12, 95% confidence interval [CI] [1.04, 1.21], P = .002), reducing visual analog scale scores (mean difference [MD] = -0.93, 95% CI [-1.29, -0.57], P < .001), reducing neck disability index scores (MD = -6.39, 95% CI [-6.79, -6.00], P < .001), and restoring cervical range of motion (cervical lateral flexion: MD = 4.29, 95% CI [3.15, 5.43], P < .001; cervical rotation: MD = 6.08, 95% CI [4.46, 7.70], P < .001).|
+^Conclusion| Acupuncture is an effective and safe method for treating stiff neck. However, to validate this conclusion, more rigorously designed and higher-quality studies are needed in the future.|
-|☆☆☆ |Preuves en faveur d’une efficacité et d’un effet spécifique de l’acupuncture. |
-|☆☆| Preuves en faveur d’une efficacité de l’acupuncture.|
-| ☆ |Preuves en faveur d’une efficacité de l’acupuncture mais limitées qualitativement et/ou quantitativement.|
-|Ø |Absence de preuve ou preuves insuffisantes.|
+=== Castellani 2022 (network meta-analysis) ===
-==== acupuncture générique ====
+Castellini G, Pillastrini P, Vanti C, Bargeri S, Giagio S, Bordignon E, Fasciani F, Marzioni F, Innocenti T, Chiarotto A, Gianola S, Bertozzi L. Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis. J Physiother. 2022 Oct;68(4):244-254.  https://doi.org/10.1016/j.jphys.2022.09.007
+^Question| Which is the most effective conservative intervention for patients with non-specific chronic neck pain (CNSNP)?|
+^Design| A systematic review and network meta-analysis of randomised clinical trials.|
+^Participants| Adults with CNSNP of at least 3 months duration.|
+^Interventions| All available pharmacological and non-pharmacological interventions.|
+^Outcome measure|The primary outcomes were pain intensity and disability. The secondary outcome was adverse events.|
+^Results|Overall, 119 RCTs (12,496 patients; 32 interventions) were included. Risk of bias was low in 50.4% of trials, unclear in 22.7% and high in 26.9%. Compared with inert treatment, a combination of active and/or passive multimodal non-pharmacological inventions (eg, exercise and manual therapy) were effective for pain on a 0-to-10 scale at 1 month (MD range 0.84 to 3.74) and at 3 to 6 months (MD range 1.06 to 1.49), and effective on disability on a 0-to-100 scale at 1 month (MD range 10.26 to 14.09) and 3 to 6 months (MD range 5.60 to 16.46). These effects ranged from possible to definite clinical relevance. Compared with inert treatment, anti-inflammatory drugs alone or in combination with another non-pharmacological treatment did not reduce pain at 1 month or 3 to 6 months. At 12 months, no superiority was found over inert treatment on both outcomes. Most mild adverse events were experienced following **acupuncture/dry needling intervention**. On average, the evidence varied from low to very low certainty.|
+^Conclusions|While multimodal non-pharmacological interventions may reduce pain and disability for up to 3 to 6 months of follow-up when compared with inert treatment, the evidence was very uncertain about their effects. Better quality and larger trials are needed to improve the certainty of evidence.|
 === Seo 2017 Ø===
@@ Ligne 167: / Ligne 200: @@
-==== Techniques particulières ====
+==== Special Acupuncture Techniques ====
-=== Acupotomie ===
+=== Comparison of acupuncture techniques ===
+== Lin 2024 ==
+Lin Y, Zhong S, Huang C, Zhang G, Jiang G. The efficacy of acupuncture therapies in cervical spondylotic radiculopathy: A network meta-analysis. Heliyon. 2024 May 27;10(11):e31793.  https://doi.org/10.1016/j.heliyon.2024.e31793
+^Objective| To evaluate the efficacy of acupuncture-related therapy in the Bayesian setting by means of a network Meta-analysis.|
+^Methods| Relevant clinical randomized controlled trials(RCTs) of acupuncture-related therapy for Cervical Spondylotic Radiculopathy(CSR) were searched in the Chinese and English databases from the inception to November 13, 2023. Two researchers reviewed the literature, extracted the data, assessed the risk of bias of the included studies independently, and then used Stata14.0 and WinBUGs14 to analyze.|
+^Results| There are **28 RCTs** in total, of which **2593 patients** and 14 acupuncture interventions. Network Meta-analysis revealed that, regarding the VAS scores, Acupoint catgut-embedding, Fu's Subcutaneous Needling and Needle Knife are better than Conventional acupuncture, Electro-acupuncture, Sham needle, Western Medicine, and Electrotherapy; Conventional acupuncture is better than Electrotherapy and Sham needle; Qihuang needle is superior to Sham needle and Electrotherapy; besides, Acupoint catgut-embedding is better than Tuina (Message), Chinese Medicine, Warm needle as well. Regarding the NDI scores, Needle Knife, Warm needle, Fire needle, Long round needle, Acupoint catgut-embedding are better than Conventional acupuncture, Electro-acupuncture, and Cervical traction; Conventional acupuncture is superior to Electro-acupuncture, Cervical traction, Needle Knife and Warm needle; whereas we found Qihuang needle is superior to Acupoint catgut-embedding, besides, Need Knife is superior to Qihuang needle, Long round needle and Acupoint catgut-embedding. In terms of improving the Tanaka Yasuhiro 20-point scale scores(TY), Needle Knife and Qihuang needle are superior to Conventional acupuncture, Warm needle and Electro-acupuncture; moreover, Conventional acupuncture is better than Warm needle.|
+^Conclusion| In general, Acupoint catgut-embedding shows the best effect at relieving neck pain, then followed by Fu's Subcutaneous Needling and Needle Knife. Needle Knife is the best intervention in improving the functionality of the cervical spine. Like improving overall clinical performance, Needle Knife is the best treatment. Furthermore, our conclusion still needs to be confirmed by higher-quality documentation. In order to choose the best treatment for patients, clinicians are expected to take into account different clinical features and practical clinical settings with caution while choosing an acupuncture-related therapy in CSR.|
+^Key message| This article aims at selecting the best acupuncture-related treatment for clinicians to help patients in CSR, and the results of this study indicated that Acupoint catgut-embedding shows the best effect in relieving neck pain, Needle Knife shows the best effect in improving the functionality of cervical spine, Needle Knife shows the best effect in treating overall clinical performance.|
+== Jo 2022 ==
+Jo HR, Noh EJ, Oh SH, Choi SK, Sung WS, Choi SJ, Kim DI, Hong SU, Kim EJ. Comparative effectiveness of different acupuncture therapies for neck pain. Medicine (Baltimore). 2022 Aug 19;101(33):e29656.  https://doi.org/10.1097/MD.0000000000029656
+^Background| Neck pain is a common musculoskeletal symptom that has negative effects on quality of life and work productivity. Acupuncture has been widely used for neck pain, and a number of randomized controlled trials (RCTs) and systematic reviews (SRs) have evaluated its effectiveness. However, previous studies have obtained inconsistent results regarding the effects of acupuncture for neck pain, and there is no SR for the comparative efficacy and safety of various types of acupuncture. Therefore, we herein conducted a SR and network meta-analysis to compare and rank different types of acupuncture with respect to their effectiveness in treating neck pain.|
+^Methods| We searched 9 electronic databases for relevant RCTs published from their inception to July 1, 2021. Pairwise meta-analyses and network meta-analysis were performed with R software using the frequentist framework. Change of pain intensity was assessed as the primary outcome, and change of pain-related disability and efficacy rate were assessed as secondary outcomes. The Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) instrument were used to evaluate the quality of the included RCTs and the certainty of the evidence.|
+^Results| A total of **65 RCTs involving 5266 participants** and **9 interventions** were included. Three network meta-analyses were constructed for the following: pain intensity (42 RCTs, 3158 participants), pain-related disability (21 RCTs, 1581 participants), and efficacy rate (40 RCTs, 3512 participants). The results indicated that fire acupuncture, electroacupuncture, and warm acupuncture were more effective than manual acupuncture in terms of pain intensity reduction and efficacy rate, and that electroacupuncture decreased pain-related disability more effectively than manual acupuncture. Fire acupuncture ranked first among the 9 interventions. The overall q of evidence was very low according to the GRADE assessment. The reported adverse events were not serious.|
+^Conclusion| Fire acupuncture, warm acupuncture, acupoint catgut embedding, and electroacupuncture ranked higher than other interventions (usual care, sham acupuncture, no treatment) in reducing the pain and disability index scores and the efficacy rate. However, the included trials were evaluated as being of low quality; thus, we recommend additional well-designed RCTs with larger sample sizes to confirm these findings.|
+=== Moxibustion ===
+== Huang 2020 ==
+Huang R, Huang Y, Huang R, Huang S, Wang X, Yu X, Xu D, Chen X. Thunder-Fire Moxibustion for Cervical Spondylosis: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2020.   {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:huang-205763.pdf|[205763]}}. [[https://dx.doi.org/10.1155/2020/5816717|doi]]
+^Background|Cervical spondylosis (CS) refers to the degenerative changes in the cervical spinal column, which affect the majority of middle-aged and elderly people. Thunder-fire moxibustion originated from thunder-fire miraculous needle, which has been applied widely for treating pain syndromes for thousands of years. |
+^Objective|The aim of our research is to provide evidence to assess the efficacy and safety of thunder-fire moxibustion in treating CS. Methods and analysis. Retrieved literature databases included Cochrane Library, MEDLINE, Web of Science, EBSCO, EBASE, Springer, PubMed, WFDP, CNKI, VIP, and CBM. The period of retrieval was from the establishment of the database to December 2018. Randomized controlled trials which compared thunder-fire moxibustion and other therapies in CS were included. The quality of inclusive trials was accessed though a Cochrane risk of bias tool. According to the test results of heterogeneity, a random effect model or fixed effect model was used to analyze the data. |
+^Results|Meta-analysis was conducted for the total effective rate of thunder-fire moxibustion, traditional Chinese medicine syndrome score, pain score, satisfaction score, and score of the symptoms and functional rehabilitation of cervical vertigo. The analysis results were as follows: compared with other therapies, the efficacy of thunder-fire moxibustion was statistically significant, total effective rate increased (OR = 2.48; 95% CI [1.80, 3.41]; P < 0.00001), traditional Chinese medicine syndrome score decreased (SMD = -3.05; 95% CI[-4.18, -1.93]; P < 0.00001), traditional Chinese medicine syndrome score decreased (SMD = -3.05; 95% CI[-4.18, -1.93]; P < 0.00001), traditional Chinese medicine syndrome score decreased (SMD = -3.05; 95% CI[-4.18, -1.93]; P < 0.00001), traditional Chinese medicine syndrome score decreased (SMD = -3.05; 95% CI[-4.18, -1.93]; P < 0.00001), traditional Chinese medicine syndrome score decreased (SMD = -3.05; 95% CI[-4.18, -1.93]. |
+^Conclusion|Based on the existing evidence, the curative effect and safety of thunder-fire moxibustion on CS were statistically significant. We should interpret the results scrupulously because of the low evidence level. Large-scale, high-quality, rigorous RCTs with long-term follow-up should be performed in the future. |
+== Wu 2018  ☆==
+Wu Si-Si, Du Chun-Yan, Liu Hong-Xia, Su Chun-Xiang, Shang Ya-Bin, Hu Yue, Li Jia-Qi. [Meta-analysis of Randomized Controlled Trials in the Treatment of Heat-sensitive Moxibustion for Cervical spondylosis]. Guiding Journal of Traditional Chinese Medicine and Pharmacy. 2018;(7):.   [115725].
+^Objective: To systematically review the clinical efficacy and safety of heat-sensitive moxibustion (HSM) therapy for cervical spondylosis.
+^Methods|All randomized clinical trials (RCTs) on the clinical efficacy and safety of HSM therapy for cervical [spondylosis were searched in CNKI, VIP, Wanfang, CBM, Pubmed, Embase database and Cochrane library by electronic and manual retrieval. The methodological quality of included studies was assessed according to the Cochrane Handbook 5. 0 and the improved Jadad scale. Then the Meta-analysis was performed using Rev Man 5. 3 software. |
+^Results|A total of **16 literatures** were included, containing with a total of **1424 patients**. The baseline data of included studies were comparable. The Meta-analysis showed that: (1) Cure rate: thermal moxibustion VS traditional moxibustion, RR=2. 05, 95%CI (1. 57, 2. 67) (P<0. 01). Thermal moxibustion VS acupuncture, RR=1. 51, 95% CI (1. 10, 2. 07) (P<0. 05) , the differences were statistically significant. (2) Effective rate: thermal moxibustion VS traditional moxibustion, RR= 1. 23, 95%CI (1. 15, 1. 32) (P<0. 01). Thermal moxibustion plus acupuncture VS acupuncture, RR=1. 17, 95% CI (1. 08, 1. 26) (P<0. 01) , the differences were statistically significant. The sensitivity analysis showed the merged results were relatively stable. Only two literatures mentioned there were no adverse reactions during the test, and the other tests did not describe the adverse reactions. Funnel plot analysis showed a publication bias in the literature. |
+^Conclusion|**Thermal moxibustion therapy for cervical spondylosis is relatively effective and safe**, but the conclusion is not clear due to the limited literatures and the suboptimal methodological quality of RCTs. So more high-quality and multi-center RCTs with large sample are needed to confirm the clinical efficacy and safety of heat-sensitive moxibustion therapy. |
+=== Warm Needle ===
+== Wang 2011 ★ ==
+Wang Yan-Wen, Fu Wen-Bin, Peng Han-Guo, Ou Ai-Hua. [Systematic reviews of clinically randomized controlled trials on warming acupuncture treating cervical spondylosis]. Liaoning Journal of Traditional Chinese Medicine. 2011;2:340-344.[187036].
+^ Objective|To assess the methodological quality and effect of clinically randomized controlled trials on warming acupuncture treatting cervical spodylosis and make out the current situation, validity of effect and applicability.|
+^ Methods|Search the PubMed, Medline, CNKI, VIP and CMAJ electronic database, and then exclud duplicated, independent and non-randomized controlled trials. At last, the trial which meet inclusion criteria was selected. To evaluate the quality of these documents with Cochrane reviews handbook 5. 0 and therapeutic effect with Review Manage 4. 2. 7 software.|
+^Results|**9 studies, total of 945 cases** were enrolled. 9 studies use response rate as primary outcome measures. Meta-analysis show there is no sufficient evidence that warming acupuncture is better than electrical acupuncture;To compares warming acupuncture with conventional acupuncture, western medicine, and comprehensive methods of warming acupuncture with electrical acupuncture, combination therapy with conservative treatmen, there is no significant advantage. |
+^Conclusion|Systematic reviews can not suggest advantages of warming acupuncture, which relate to small sample studies, low quality literature. **Attention must be paid to synergism of acupuncture and moxibustion,** randomized controlled trials of large sample and high-quality on warming acupuncture treating cervical spodylosis, A practicable blinding of acupuncture is the pressing problem at present.|
+=== Acupotomy ===
 == Fang 2017 ★ ==
@@ Ligne 204: / Ligne 292: @@
 ^Results and conclusions|A total of **10 randomized controlled trials involving 1085 patients** were included. Meta-analysis showed that the **total effective rate and cure rate of acupotomy group were significantly higher than those of acupuncture and moxibustion group, and the improvement of symptom scores was better than acupuncture and moxibustion group, which indicated that acupuncture treatment had better curative effect than acupuncture** . However, the number of articles included in the trial is limited and the quality of the literature is low, the need to design more stringent randomized controlled trials to further verify the above conclusions.|
-=== Acupuncture abdominale ===
+=== Electro-acupuncture ===
+== Yang G 2006 ★ ==
+Yang G, Wang XQ. [Systematic review of efficacy of electro-acupuncture treatment of cervical disease]. Beijing J Trad Chinese Med. 2006; 25(7):433-5.  {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:yang-181530.pdf|[181530].}}
+^Objective|To evaluate acupuncture treatment of cervical spondylosis effects.|
+^Methods|We searched Medline, Embase, Lilacs, Chinese Biomedical Literature Database and Cochrane muscle disease group Registration database retrieval time for the deadline to June 2005; at the same time to retrieve other relevant gray literature get all involved in acupuncture treatment of cervical disease in randomized controlled trials. Then select met the inclusion criteria for clinical trials to evaluate their methodological quality, and extracted the basic condition of the patient, and other interventions, outcome measures and results Info systematic evaluation.|
+^Results| a total of **five randomized controlled trials in a total of 626 cases** of patients met the inclusion criteria, but because of the existence of obvious defects exist between test and large differences in experimental design, the report does not meet the conditions of Meta-analysis, therefore only qualitative analysis. The results for the three acupuncture trials test group showed that acupuncture treatment of cervical disease than the traction or Western medicine has a good effect (P <0.05); but EA is two experimental group showed that acupuncture efficacy of combination therapy is better (P <0.05).|
+^Conclusion|**the present limited the included trials showed that acupuncture treatment of cervical disease has a certain effect in improving symptoms**, acupuncture for treatment of cervical spondylosis superiority still need more high quality, good internal validity It randomized controlled trials to confirm.|
+=== Laser therapy ===
+== Chow 2009 ★★ ==
+Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet. 2009;374(9705):1897-908.   {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:chow-133480.pdf|[133480]}}
+^Background|Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain.|
+^Methods|We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain. Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale.|
+^Findings| We identified **16 randomised controlled trials including a total of 820 patients**. In acute neck pain, results of two trials showed a relative risk (RR) of 1.69 (95% CI 1.22-2.33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4.05 (2.74-5.98) of LLLT. Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19.86 mm (10.04-29.68). Seven trials provided follow-up data for 1-22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22.07 mm (17.42-26.72). Side-effects from LLLT were mild and not different from those of placebo.|
+^Interpretation|We show that **LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.**|
+=== Dry Needling ===
+== Cagnies 2015 ★ ==
+Cagnie B, Castelein B, Pollie F, Steelant L, Verhoeyen H, Cools A.  Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in patients with neck pain: a systematic review. Am J Phys Med Rehabil. 2015. 94(7):573-83.  [183455].
+^Purpose|The aim of this review was to describe the effects of ischemic compression and dry needling on trigger points in the upper trapezius muscle in patients with neck pain and compare these two interventions with other therapeutic interventions aiming to inactivate trigger points. |
+^Methods|Both PubMed and Web of Science were searched for randomized controlled trials using different key word combinations related to myofascial neck pain and therapeutic interventions. Four main outcome parameters were evaluated on short and medium term: pain, range of motion, functionality, and quality-of-life, including depression. |
+^Results|**Fifteen randomized controlled trials** were included in this systematic review. There is moderate evidence for ischemic compression and **strong evidence for dry needling to have a positive effect on pain intensity**. This pain decrease is greater compared with active range of motion exercises (ischemic compression) and no or placebo intervention (ischemic compression and dry needling) but similar to other therapeutic approaches. There is moderate evidence that both ischemic compression and dry needling increase side-bending range of motion, with similar effects compared with lidocaine injection. There is weak evidence regarding its effects on functionality and quality-of-life. |
+^Conclusions|On the basis of this systematic review, ischemic compression and **dry needling can both be recommended in the treatment of neck pain patients with trigger points in the upper trapezius muscle**. Additional research with high-quality study designs are needed to develop more conclusive evidence.|
+=== Abdominal Acupuncture ===
 == Wang 2011 ★ ==
@@ Ligne 226: / Ligne 353: @@
 ^ Results|A total of **10 trials involving 1 104 patients** were included. Meta analyses showed that compared with conventional acupuncture and electro-acupuncture the abdominal acupuncture showed abdominal acupuncture more effective than conventional acupuncture and electro-acupuncture;compared the abdominal acupuncture with the cervical vertebra traction, showed the effective rate of abdominal acupuncture was higher than the cervical vertebra traction.|
 ^Conclusion|The Meta-analysis showed **the abdominal acupuncture in the treatment for cervical spondylosis has advantages**. However, the evidence is not strong enough because of some of the low-quality trials and publications bias. Large sample, high-quality, multicenter, rigorous designs trials of abdominal acupuncture for cervical spondylosis are needed to further assess the effect.|
-=== Electro-acupuncture ===
-== Yang G 2006 ★ ==
-Yang G, Wang XQ. [Systematic review of efficacy of electro-acupuncture treatment of cervical disease]. Beijing J Trad Chinese Med. 2006; 25(7):433-5.  {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:yang-181530.pdf|[181530].}}
-^Objective|To evaluate acupuncture treatment of cervical spondylosis effects.|
-^Methods|We searched Medline, Embase, Lilacs, Chinese Biomedical Literature Database and Cochrane muscle disease group Registration database retrieval time for the deadline to June 2005; at the same time to retrieve other relevant gray literature get all involved in acupuncture treatment of cervical disease in randomized controlled trials. Then select met the inclusion criteria for clinical trials to evaluate their methodological quality, and extracted the basic condition of the patient, and other interventions, outcome measures and results Info systematic evaluation.|
-^Results| a total of **five randomized controlled trials in a total of 626 cases** of patients met the inclusion criteria, but because of the existence of obvious defects exist between test and large differences in experimental design, the report does not meet the conditions of Meta-analysis, therefore only qualitative analysis. The results for the three acupuncture trials test group showed that acupuncture treatment of cervical disease than the traction or Western medicine has a good effect (P <0.05); but EA is two experimental group showed that acupuncture efficacy of combination therapy is better (P <0.05).|
-^Conclusion|**the present limited the included trials showed that acupuncture treatment of cervical disease has a certain effect in improving symptoms**, acupuncture for treatment of cervical spondylosis superiority still need more high quality, good internal validity It randomized controlled trials to confirm.|
-=== Laserthérapie ===
+=== Wrist-ankle Acupuncture ===
-== Chow 2009 ★★ ==
-Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet. 2009;374(9705):1897-908.   {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:chow-133480.pdf|[133480]}}
-^Background|Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain.|
-^Methods|We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain. Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale.|
-^Findings| We identified **16 randomised controlled trials including a total of 820 patients**. In acute neck pain, results of two trials showed a relative risk (RR) of 1.69 (95% CI 1.22-2.33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4.05 (2.74-5.98) of LLLT. Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19.86 mm (10.04-29.68). Seven trials provided follow-up data for 1-22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22.07 mm (17.42-26.72). Side-effects from LLLT were mild and not different from those of placebo.|
-^Interpretation|We show that **LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.**|
+== Fu 2018 ==
-=== Moxibustion ===
-== Wu 2018  ☆==
+Fu Yingyue, Dong Longcong, Pan Jianxiang, Xiang Kaiwei. [A Meta-analysis on Treating Cervical Spondylotic Radiculopathy with Wrist-ankle Acupuncture and its Combination Therapy]. Journal of Guiyang College of Traditional Chinese Medicine. 2018;5:34-40.   [201779].
+|目的:系统评价腕踝针及腕踝针联合其他疗法对神经根型颈椎病患者的临床疗效.方法:计算机检索CNKI、万方数据库、CBM、PubMed、Embass、Medline数据库,检索时间为建库至2018年5月.由两位研究员独立筛选文献,提取文献资料及评估偏倚风险并采用RevMan5.3软件对数据进行分析.结果:共纳入12个RCT,总样本量为979例,试验组510例,对照组469例.Meta分析结果显示:10个研究显示腕踝针及联合疗法组治疗本病的有效率优于使用非腕踝针疗法组[OR=2.79,95％CI(1.87,4.16),P＜0.00001],单纯腕踝针组与非腕踝针组有效率相当[OR=0.75,95％CI(0.24,2.31),P=0.62],而其联合疗法组则优于非腕踝针组[OR=3.14,95％CI(1.99,4.97),P＜0.00001];8个研究显示腕踝针组及其联合疗法组对患者的VAS评分水平改善均优于非腕踝针组[WMD=-1.06,95％ CI(-1.69-0.43),P=0.001].结论:腕踝针及其联合疗法在治疗本病的临床有效率与缓解疼痛方面较非腕踝针疗法具有优势性.但受限于所纳入文献质量普遍不高、数量较少等因素,本研究结论可能存在偏倚,还需将来开展更多高质量的随机对照双盲试验予以验证. ||
+^OBJECTIVE|To systematically evaluate the clinical efficacy of wrist-ankle and wrist-ankle combined with other therapies in patients with cervical spondylotic radiculopathy. |
+^ Methods| Computer search CNKI, Wanfang database, CBM, PubMed, Embass, Medline database, the retrieval time is built to In May 2018, two researchers independently screened the literature, extracted literature data and assessed the risk of bias and analyzed the data using RevMan5.3 software. |
+^Results|A total of 12 RCTs were included, with a total sample size of 979 cases and a test group of 510 cases. 469 cases in the control group. Meta-analysis showed that 10 studies showed that the treatment of this disease was better in the treatment of this disease than in the non-wrist-ankle group [OR=2.79, 95% CI (1.87, 4.16) , P <0.00001], the simple wrist-twist group and the non-wrist-needle group were equally effective [OR=0.75, 95% CI (0.24, 2.31), P=0.62], while the combination therapy group was superior to the non-wristing group. The needle group [OR=3.14, 95% CI (1.99, 4.97), P<0.00001]; 8 studies showed that the wristband and the combination therapy group improved the VAS score of the patients better than the non-wrist ankle group [ WMD=-1.06, 95% CI (-1.69-0.43), P=0.001]. |
+^Conclusion|Wrist-ankle and its combination therapy are effective in treating the disease and alleviating pain. It is more advantageous than non-ankle-ankle acupuncture. However, due to factors such as the generally low quality and low quantity of the included literature, the conclusions of this study may be biased, and more high-quality randomized controlled double-blind trials will be needed in the future. verification. |
-Wu Si-Si, Du Chun-Yan, Liu Hong-Xia, Su Chun-Xiang, Shang Ya-Bin, Hu Yue, Li Jia-Qi. [Meta-analysis of Randomized Controlled Trials in the Treatment of Heat-sensitive Moxibustion for Cervical spondylosis]. Guiding Journal of Traditional Chinese Medicine and Pharmacy. 2018;(7):.   [115725].
-^Objective: To systematically review the clinical efficacy and safety of heat-sensitive moxibustion (HSM) therapy for cervical spondylosis.
-^Methods|All randomized clinical trials (RCTs) on the clinical efficacy and safety of HSM therapy for cervical [spondylosis were searched in CNKI, VIP, Wanfang, CBM, Pubmed, Embase database and Cochrane library by electronic and manual retrieval. The methodological quality of included studies was assessed according to the Cochrane Handbook 5. 0 and the improved Jadad scale. Then the Meta-analysis was performed using Rev Man 5. 3 software. |
-^Results|A total of **16 literatures** were included, containing with a total of **1424 patients**. The baseline data of included studies were comparable. The Meta-analysis showed that: (1) Cure rate: thermal moxibustion VS traditional moxibustion, RR=2. 05, 95%CI (1. 57, 2. 67) (P<0. 01). Thermal moxibustion VS acupuncture, RR=1. 51, 95% CI (1. 10, 2. 07) (P<0. 05) , the differences were statistically significant. (2) Effective rate: thermal moxibustion VS traditional moxibustion, RR= 1. 23, 95%CI (1. 15, 1. 32) (P<0. 01). Thermal moxibustion plus acupuncture VS acupuncture, RR=1. 17, 95% CI (1. 08, 1. 26) (P<0. 01) , the differences were statistically significant. The sensitivity analysis showed the merged results were relatively stable. Only two literatures mentioned there were no adverse reactions during the test, and the other tests did not describe the adverse reactions. Funnel plot analysis showed a publication bias in the literature. |
-^Conclusion|**Thermal moxibustion therapy for cervical spondylosis is relatively effective and safe**, but the conclusion is not clear due to the limited literatures and the suboptimal methodological quality of RCTs. So more high-quality and multi-center RCTs with large sample are needed to confirm the clinical efficacy and safety of heat-sensitive moxibustion therapy. |
+==== Special Clinical Forms ====
+=== Acute Neck Pain, Whiplash Syndrome ===
-== Wang 2011 ★ ==
+| See [[acupuncture:evaluation:rhumatologie - orthopedie:12. cervicalgies aigues|corresponding item]] |
-Wang Yan-Wen, Fu Wen-Bin, Peng Han-Guo, Ou Ai-Hua. [Systematic reviews of clinically randomized controlled trials on warming acupuncture treating cervical spondylosis]. Liaoning Journal of Traditional Chinese Medicine. 2011;2:340-344.[187036].
+===== Cost-Effectiveness Analysis  =====
-^ Objective|To assess the methodological quality and effect of clinically randomized controlled trials on warming acupuncture treatting cervical spodylosis and make out the current situation, validity of effect and applicability.|
-^ Methods|Search the PubMed, Medline, CNKI, VIP and CMAJ electronic database, and then exclud duplicated, independent and non-randomized controlled trials. At last, the trial which meet inclusion criteria was selected. To evaluate the quality of these documents with Cochrane reviews handbook 5. 0 and therapeutic effect with Review Manage 4. 2. 7 software.|
-^Results|**9 studies, total of 945 cases** were enrolled. 9 studies use response rate as primary outcome measures. Meta-analysis show there is no sufficient evidence that warming acupuncture is better than electrical acupuncture;To compares warming acupuncture with conventional acupuncture, western medicine, and comprehensive methods of warming acupuncture with electrical acupuncture, combination therapy with conservative treatmen, there is no significant advantage. |
-^Conclusion|Systematic reviews can not suggest advantages of warming acupuncture, which relate to small sample studies, low quality literature. **Attention must be paid to synergism of acupuncture and moxibustion,** randomized controlled trials of large sample and high-quality on warming acupuncture treating cervical spodylosis, A practicable blinding of acupuncture is the pressing problem at present.|
-=== Trigger points ===
+|See [[acupuncture:evaluation:03. etudes cout-efficacite#Neck Pain and Whiplash syndrome|corresponding item]] |
-== Cagnies 2015 ★ ==
-Cagnie B, Castelein B, Pollie F, Steelant L, Verhoeyen H, Cools A.  Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in patients with neck pain: a systematic review. Am J Phys Med Rehabil. 2015. 94(7):573-83.  [183455].
-^Purpose|The aim of this review was to describe the effects of ischemic compression and dry needling on trigger points in the upper trapezius muscle in patients with neck pain and compare these two interventions with other therapeutic interventions aiming to inactivate trigger points. |
-^Methods|Both PubMed and Web of Science were searched for randomized controlled trials using different key word combinations related to myofascial neck pain and therapeutic interventions. Four main outcome parameters were evaluated on short and medium term: pain, range of motion, functionality, and quality-of-life, including depression. |
-^Results|**Fifteen randomized controlled trials** were included in this systematic review. There is moderate evidence for ischemic compression and **strong evidence for dry needling to have a positive effect on pain intensity**. This pain decrease is greater compared with active range of motion exercises (ischemic compression) and no or placebo intervention (ischemic compression and dry needling) but similar to other therapeutic approaches. There is moderate evidence that both ischemic compression and dry needling increase side-bending range of motion, with similar effects compared with lidocaine injection. There is weak evidence regarding its effects on functionality and quality-of-life. |
-^Conclusions|On the basis of this systematic review, ischemic compression and **dry needling can both be recommended in the treatment of neck pain patients with trigger points in the upper trapezius muscle**. Additional research with high-quality study designs are needed to develop more conclusive evidence.|
-==== Formes cliniques particulières ====
-=== Cervicalgies aiguës, Whiplash syndrome ===
+===== Clinical Practice Guidelines =====
-| Voir  l' [[acupuncture:evaluation:rhumatologie - orthopedie:12. cervicalgies aigues|article correspondant]] |
-===== Etudes coût-efficacité  =====
+| ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) |
-|Voir l' [[acupuncture:evaluation:etudes cout-efficacite#Whiplash syndrome et cervicalgies|article correspondant]] |
+==== German Society of General Practice and Family Medicine (DEGAM, Germany) 2025 ⊕ ====
+El-Allawy A, Hecht N, Luedtke K, Schleicher P, Weidner N, Kötter T. Clinical Practice Guideline: Nonspecific Neck Pain. Dtsch Arztebl Int. 2025 Oct 3;122(20):552-557. https://doi.org/10.3238/arztebl.m2025.0119
+|Acupuncture (for the treatment of chronic nonspecific neck pain in combination with activating methods; LoE I)|
+==== American Psychological Association (APA, USA) 2024 ⊕ ====
+American Psychological Association (2024). Guideline for Psychological and Other Nonpharmacological Treatment of Chronic Musculoskeletal Pain in Adults. Retrieved from https://www.apa.org/practice/guidelines/nonpharmacological-treatment-chronic-musculoskeletal-pain.pdf
-===== Recommandation de bonne pratique =====
+| For patients //with chronic neck pain//, the panel suggests offering patients acupuncture over sham, placebo, or usual care for shortand intermediate-term pain relief (Strength/Direction: Conditional For).|
+==== Centers for Disease Control and Prevention (CDC, USA) 2022 ⊕====
-| ⊕ recommandation positive (quel que soit le niveau de preuve annoncé) \\ Ø recommandation négative (ou absence de preuve) |
+ Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95. https://doi.org/10.15585/mmwr.rr7103a1
+| Clinicians should recommend appropriate noninvasive nonpharmacologic approaches to help manage chronic pain, such as [...] mind-body practices (e.g., yoga, tai chi, or qigong), massage, and **acupuncture** for //neck pain//. ||
+==== American Academy of Family Physicians (AAFP, USA) 2021 ⊕ ====
+AAFP Chronic Pain Toolkit. American Academy of Family Physicians. 2021.   [188191].   [[https://www.aafp.org/dam/AAFP/documents/patient_care/pain_management/cpm-toolkit.pdf|URL]]
+|Chronic pain : Non-opioid analgesics, physical therapy, cognitive behavioral therapy, rehabilitation, exercise, integrative medical therapies (e.g., yoga, relaxation, tai chi, massage, and **acupuncture**), opioids on a case-by-case basis. \\ Acupuncture : indications Low back pain, fibromyalgia, chronic headache, **neck pain**. Magnitude to benefit pain and function: small to moderate. |
+==== Agency for Care Effectiveness, Ministry of Health (ACE, Singapore) 2020 ⊕ ====
+Technology Guidance from the MOH Medical Technology Advisory Committee. Acupuncture for adults with low back pain and neck pain. Agency for Care Effectiveness, Ministry of Health, Republic of Singapore. 2020.   {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:moh-196853.pdf|[196853]}}.   [[https://www.ace-hta.gov.sg/docs/default-source/med-tech/acupuncture-for-adults-with-low-back-pain-and-neck-pain.pdf|URL]].
+| Guidance Recommendations.  The Ministry of Health’s Medical Technology Advisory Committee has recommended: Needled acupuncture (with or without electro stimulation) performed in public healthcare institutions (PHIs) for pain reduction or functional improvement in adults aged 18 years and above as clinically appropriate for: \\ - Low back pain, \\ - **Neck pain**, including pain radiating to the neck, or from neck to shoulders. \\ It can be administered for up to 12 sessions within 3 months from treatment initiation following formal diagnosis and recommendation by a referring medical specialist in a PHI.  Subsequent treatment up to 12 more sessions within the next 3 months is subject to the reviewing medical specialist’s assessment of sustained pain reduction or functional improvement for the patient. It shall be performed by acupuncturists registered with the Traditional Chinese Medicine Practitioners Board (TCMPB) in accordance with minimum practice standards defined by the TCM Branch of MOH. \\   Subsidy status.  Subsidy for needled acupuncture (with or without electro stimulation) for the above mentioned criteria is applicable only for treatments performed in public healthcare institutions.|
+==== Agency for Healthcare Research and Quality (ARQ, USA) 2020 ⊕ ====
+Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Kantner S, Ferguson AJR. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update [Internet]. . 2020;:607p.   {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:skelly-208656.pdf|[208656]}}. [[http://www.ncbi.nlm.nih.gov/books/nbk556229|doi]]
+|Interventions that improved function and/or pain for ≥1 month:  Exercise, low-level laser, mind-body practices, massage, **acupuncture**. \\  //Acupuncture//: Acupuncture was associated with small improvements in short-term (5 trials) and intermediate-term (3 trials) function versus sham acupuncture, a placebo (sham laser), or usual care; one trial reported no difference in function in the long term (SOE: low for all time periods). For pain, there were no differences for acupuncture versus sham acupuncture or placebo interventions in the short (4 trials), intermediate (3 trials), or long (1 trial) term (SOE: low for all time periods).|
 ==== AIM Specialty Health (USA) 2019 ⊕ ====
@@ Ligne 308: / Ligne 434: @@
 Spine Surgery. Musculoskeletal Program Clinical Appropriateness Guidelines. AIM Specialty Health. 2019;:42P.   {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:aim-198043.pdf|[198043]}}.
 |//Cervical Decompression With or Without Fusion/ Cervical Disc Arthroplasty/ Lumbar Disc Arthroplasty/ Lumbar Discectomy, Foraminotomy, and Laminotomy/ Lumbar Fusion and Treatment of Spinal Deformity (including Scoliosis and Kyphosis)/ Lumbar Laminectomy.// Conservative management should include a combination of strategies to reduce inflammation, alleviate pain, and improve function, including but not limited to the following: [Alternative therapies such as **acupuncture**]. The requirement for a period of conservative treatment as a prerequisite to a surgical procedure is waived when there is evidence of progressive nerve or spinal cord compression resulting in a significant neurologic deficit, or when myelopathy, weakness, or bladder disturbance is present.|
+==== American Chronic Pain Association (ACPA, USA) 2019 ⊕ ====
+American Chronic Pain Association Resource Guide to Chronic Pain management, An Integrated Guide to Medical, Interventional, Behavioral Pharmacologic and Rehabilitation Therapies. Feinberg S (ed.) American Chronic Pain Association Inc., Rocklin, California. 2019:156p.   [219425]. [[https://pharmacy.envolvehealth.com/content/dam/centene/envolve-pharmacy-solutions/pdfs/EnvolvePSForms/acpa-resource-guide-2019.pdf|URL]]
+| Acupuncture has been gaining popularity in the United States since the 1970s, and, in wake of increasing acceptance by both the public and medical professionals, it is now covered by many insurance policies. In the field of chronic pain medicine, there is a strong body of research supporting the efficacy of acupuncture for headache, osteoarthritis, and musculoskeletal conditions, such as **neck** and lower back pain|.
 ==== Agency for Healthcare Research and Quality (ARQ, USA) 2018 ⊕ ====
@@ Ligne 338: / Ligne 473: @@
 |For treatment, guidelines suggest acupuncture for neck pain but not for cervical radiculopathy. |
+==== Finnish Medical Association, Societas Medicinae Physicalis et Rehabilitationis Fenniae and the Finnish Association of General Practitioners (Finland) 2017 ⊕ ====
+[Neck pain (adults)]. Duodecim of the Finnish Medical Association, Societas Medicinae Physicalis et Rehabilitationis Fenniae and the Finnish Association of General Practitioners. 2017;:18P.   [219465]. [[https://www.kaypahoito.fi/xmedia/hoi/hoi20010.pdf|URL]]
+|Acupuncture may temporarily relieve chronic neck pain [118, 119, 125, 131, 132] C, but there is no evidence of longer-term efficacy.|
+==== Institute for Clinical and Economic Review (ICER, USA) 2017 ∅ ====
+Tice JA, Kumar V, Otuonye I, et al. Cognitive and Mind-Body Therapies for Chronic Low Back and Neck Pain: Effectiveness and Value, Final Evidence Report. The Institute for Clinical and Economic Review (ICER). 2017;:171p.   [219448]. [[http://icerorg.wpengine.com/wp-content/uploads/2020/10/CTAF_LBNP_Final_Evidence_Report_110617.pdf|URL]]
+| Chronic Neck Pain. Acupuncture. Net Health Benefit: Small. Level of Certainty: Low. ICER Evidence Rating: C+: P/I: Promising, but inconclusive.|
 ==== American College of Occupational and Environmental Medicine (ACOEM, USA) 2016  ⊕ ====
@@ Ligne 343: / Ligne 497: @@
 Cervical and spine disorders. American College of Occupational and Environmental Medicine. 2016. 711P.   {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:acoem-181753.pdf|[181753].}}
 | Recommendation: **Acupuncture for Chronic Cervicothoracic Pain.** Acupuncture is recommended for select use in chronic cervicothoracic pain with or without radicular symptoms as an adjunct to facilitate more effective treatments. //Indications// - As an adjunct treatment option for chronic cervicothoracic pain as a limited course during which time there are clear objective and functional goals that are to be achieved. Considerations include time-limited use in chronic cervicothoracic pain patients without underlying serious pathology as an adjunct to a conditioning program that has both graded aerobic exercise and strengthening exercises. Acupuncture is recommended to assist in increasing functional activity levels more rapidly, and, if it is recommended, the primary attention should remain on the conditioning program. In those not involved in a conditioning program, or who are non-compliant with graded increases in activity levels, this intervention is not recommended. //Frequency/Duration// - Different frequencies and numbers of treatments used in quality studies ranged from weekly for 1 month to 20 appointments over 3 months. Usual program is 10 sessions over 3 to 4 weeks.(881 ) An initial trial of 5 to 6 appointments is recommended in combination with a conditioning program of aerobic and strengthening exercises. Future appointments should be tied to improvements in objective measures to justify an additional 6 sessions, for a total of 12 sessions.  //Indications for Discontinuation// - Resolution, intolerance, or non-compliance including noncompliance with aerobic and strengthening exercises. \\//Harms// - Rare needling of deep tissue, such as artery, lung, etc. and resultant complications. Use of acupuncture may theoretically increase reliance on passive modality(ies) for chronic pain. //Benefits// - Modest reduction in pain.  //Strength of Evidence// - Recommended, Evidence C.// Level of Confidence// – Low |
+==== Canadian Chiropractic Association (CCA, Canada) 2016 Ø  ====
+Bussières AE, Stewart G, Al-Zoubi F, Decina P, Descarreaux M, Hayden J, Hendrickson B, Hincapié C, Pagé I, Passmore S, Srbely J, Stupar M, Weisberg J, Ornelas J. The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. J Manipulative Physiol Ther. 2016 Oct;39(8):523-564.e27. https://doi.org/10.1016/j.jmpt.2016.08.007
+| Treatment Interventions That Should NOT Be Offered for Neck Pain–Associated Disorders (NAD) grade I-II : electroacupuncture |
+==== Ontario Protocol for Traffic InjuryManagement Collaboration ((OPTIMa, Canada) 2016 Ø ====
+Côté P, Wong JJ, Sutton D, et al. Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J. 2016;25(7):2000–2022. doi:10.1007/s00586-016-4467-7. {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:cote-001.pdf|[001]}}. [[https://doi.org/10.1007/s00586-016-4467-7|DOI]]
+|// Recommendation 4 For NAD grades I–II  ≤ 3 months duration//,In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar,** electroacupuncture**, electrotherapy, or clinic-based heat \\ //Recommendation 5 For NAD grades I–II  ≥3 months duration//, In view of evidence of no effectiveness, clinicians should not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, **electroacupuncture**, or botulinum toxin injections.|
 ==== Colorado Division of Workers' Compensation (USA) 2014 ⊕ ====
@@ Ligne 381: / Ligne 548: @@
 | The evidence for the effectiveness of acupuncture is most convincing for the treatment of chronic neck and shoulder pain. In terms of other injuries, the evidence is either inconclusive or insufficient. The state of the evidence on the effectiveness of acupuncture is not dissimilar to other physical therapies such as physiotherapy, chiropractic and osteopathy. \\ // General // \\ - There is insufficient evidence to make a recommendation for the use of acupuncture in the management of acute neck, back or shoulder pain \\ - There is emerging evidence that acupuncture may enhance/facilitate other conventional therapies (including physiotherapy & exercise-based therapies) \\ - There is a paucity of research for the optimal dosage of acupuncture treatment for treating shoulder, knee, neck and lower back pain \\ - Studies comparing effective conservative treatments (including simple analgesics, physical therapy, exercise, heat & cold therapy) for (sub) acute and chronic non-specific low back pain (LBP) have been largely inconclusive. \\  //Neck// \\ - There is good evidence that acupuncture is effective for short term pain relief in the treatment of chronic neck pain \\ - There is moderate evidence that real acupuncture is more effective than sham acupuncture for the treatment of chronic neck pain \\ - There is limited evidence that acupuncture has a long term effect on chronic neck pain  |
+==== The Swedish Council on Technology Assessment in Health Care, Statens beredning för medicinsk utvärdering (SBU, Sweden) 2006 ⊕ ====
+Axelsson S, Boivie J, Eckerlund I, Gerdle B, Johansson E, Kristiansson M, List T, Lundberg B, Mannheimer C et al. Metoder för behandling av långvarig smärta [Methods of treating chronic pain]. SBU. Statens beredning för medicinsk utvärdering. The Swedish Council on Technology Assessment in Health Care;  Stockholm. 2006;:508.   {{:medias securises:acupuncture:evaluation:stomatologie:sbu-199760.pdf|[199760]}}.
+|//Neck pain//. Acupuncture. Evidence Force 3 - Limited scientific evidence \\ //Whiplash-related pain//. Acupuncture. Evidence Force 3 - Limited scientific evidence |
+===== Review of Clinical Practice Guidelines =====
+==== Ng 2022 ====
+Ng JY, Uppal M, Steen J. Neck pain clinical practice guidelines: a systematic review of the quality and quantity of complementary and alternative medicine recommendations. Eur Spine J. 2022 Oct;31(10):2650-2663. https://doi.org/10.1007/s00586-022-07288-7

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